Roncalli Massimo, Sciarra Amedeo, Tommaso Luca Di
Pathology Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
Clin Mol Hepatol. 2016 Jun;22(2):199-211. doi: 10.3350/cmh.2016.0101. Epub 2016 May 18.
Owing to the progress of imaging techniques, benign hepatocellular nodules are increasingly discovered in the clinical practice. This group of lesions mostly arises in the context of a putatively normal healthy liver and includes either pseudotumoral and tumoral nodules. Focal nodular hyperplasia and hepatocellular adenoma are prototypical examples of these two categories of nodules. In this review we aim to report the main pathological criteria of differential diagnosis between focal nodular hyperplasia and hepatocellular adenoma, which mainly rests upon morphological and phenotypical features. We also emphasize that for a correct diagnosis the clinical context such as sex, age, assumption of oral contraceptives, associated metabolic or vascular disturbances is of paramount importance. While focal nodular hyperplasia is a single entity epidemiologically more frequent than adenoma, the latter is representative of a more heterogeneous group which has been recently and extensively characterized from a clinical, morphological, phenotypical and molecular profile. The use of the liver biopsy in addition to imaging and the clinical context are important diagnostic tools of these lesions. In this review we will survey their systematic pathobiology and propose a diagnostic algorithm helpful to increase the diagnostic accuracy of not dedicated liver pathologists. The differential diagnosis between so-called typical and atypical adenoma and well differentiated hepatocellular carcinoma will also be discussed.
由于成像技术的进步，良性肝细胞结节在临床实践中越来越多地被发现。这组病变大多发生在假定正常的健康肝脏背景下，包括假肿瘤性和肿瘤性结节。局灶性结节性增生和肝细胞腺瘤是这两类结节的典型例子。在本综述中，我们旨在报告局灶性结节性增生和肝细胞腺瘤之间鉴别诊断的主要病理标准，这主要基于形态学和表型特征。我们还强调，对于正确诊断而言，临床背景如性别、年龄、口服避孕药的使用、相关的代谢或血管紊乱至关重要。虽然局灶性结节性增生在流行病学上比腺瘤更常见，但腺瘤代表了一个更具异质性的群体，最近已从临床、形态学、表型和分子特征方面进行了广泛描述。除了成像和临床背景外，肝活检的应用是这些病变的重要诊断工具。在本综述中，我们将概述它们的系统病理生物学，并提出一种有助于提高非专业肝脏病理学家诊断准确性的诊断算法。还将讨论所谓典型和非典型腺瘤与高分化肝细胞癌之间的鉴别诊断。
